Several program updates were shared at the Feb. 6 meeting with representatives from Healthy Way LA (HWLA).

Deployment of new resources has recently resulted in about 1,000 claims for inpatient services being released for payment. The remaining balance of approximately 632 cases, which exceed the 30 days, will be resolved shortly.

Concurrent review is also a problem with a few hospitals. HWLA will reach out to individual UM managers at those specific facilities to discuss the individual cases and review the identified problem areas. Staff training will also be offered.

HWLA is requesting that all hospitals use a UM Resource Sheet to identify information that must be submitted moving forward. In addition, a new tab in the HWLA website called “For Private Hospitals” will be developed and will contain these forms as well as any other relevant information for hospitals to access.

Mental health benefit and the challenge of moving a patient who is medically cleared from a non-designated hospital was also discussed. Because the mental health benefit is administered directly by LA County DMH, HWLA representatives agreed to follow up with DMH directly to address the inpatient/psych issue as soon as possible.

Finally, effective January 1, 2014, individuals enrolled in HWLA will move to Medi-Cal as part of the coverage expansion under the Affordable Care Act. HWLA is working with LA Care Health Plan and Health Net on developing a communication plan for members to advise them of the upcoming change.

Contact: Jaime Garcia
(213) 538-0702, jgarcia@hasc.org